In 2002, one bus per day connected Garissa, in Kenya's North-Eastern Province, with the capital, Nairobi, and not a single case of HIV had been reported in the region.
By 2008, 30 buses were running between the two cities, bringing better access to goods and services, and more interaction between the traditionally conservative people of North-Eastern Province and the rest of the country. New research has shown that these interactions may also be contributing to an increase in HIV infections in the region.
A study by the AIDS, Population and Health Integrated Assistance programme, funded by USAID, found that although the HIV prevalence of just over one percent in North-Eastern Province was still significantly lower than the estimated national average of around eight percent, the sexual risk behaviours of people in Garissa were similar to those of other Kenyans.
Researchers assessed HIV risk behaviours in key groups - including students, taxi drivers, milk traders and truck drivers - living in Garissa, and also in the Nairobi neighbourhood of Eastleigh, which is largely populated by people from the northeast.
They found that 22 percent of male respondents and 35 percent of female respondents in Garissa had engaged in transactional sex, while nine percent of men surveyed and 14 percent of women surveyed had been forced to have sex.
More than half the young people surveyed reported having multiple sexual partners and engaging in sex to acquire cell phones, clothing and jewellery; 41 percent of those with a regular sexual partner never used a condom.
"A friend can ask you to have a 'puff' [a brief sex session] with the lady he is pushing with," one Garissa student told researchers. "Such puffs become frequent and the lady ends up having many sexual partners at the same time."
The study also showed that many people from North-Eastern Province had low levels of knowledge about HIV, heightening their risk. Only one-third of the men and a quarter of the women named consistent condom use as a way to prevent HIV transmission, while just over half the women and 39 percent of the men identified faithfulness to one partner as a prevention strategy.
In Nairobi the main sources of information about HIV were television and other media, while in Garissa most people learned about it from religious leaders, parents and other family members.
Misconceptions about how HIV is transmitted were common, and almost 75 percent of respondents in both Garissa and Eastleigh believed that AIDS was a punishment from God. Stigma and discrimination against people living with HIV were higher in Garissa, but were also present in Eastleigh.
"The government always quarantines sick animals to protect those that are healthy; it should do the same to people with HIV/AIDS - we must be protected," Ibrahim Dekow, a miraa (local herbal stimulant) trader in Garissa, told IRIN/PlusNews.
The authors recommended intensifying HIV education programmes at schools, and targeting high-risk groups like miraa and milk vendors, sex workers and out-of-school youth with prevention programmes.
They also suggested working with religious leaders and using familiar faces - such as local women wearing the customary Islamic headscarf, or hijab - to deliver HIV prevention messages.
"We need a special approach to the HIV/AIDS programme in this province," said Anab Haji, of Garissa Simaho, a local community health organisation. "We are very different to other parts of Kenya, and our problems require different solutions."
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By 2008, 30 buses were running between the two cities, bringing better access to goods and services, and more interaction between the traditionally conservative people of North-Eastern Province and the rest of the country. New research has shown that these interactions may also be contributing to an increase in HIV infections in the region.
A study by the AIDS, Population and Health Integrated Assistance programme, funded by USAID, found that although the HIV prevalence of just over one percent in North-Eastern Province was still significantly lower than the estimated national average of around eight percent, the sexual risk behaviours of people in Garissa were similar to those of other Kenyans.
Researchers assessed HIV risk behaviours in key groups - including students, taxi drivers, milk traders and truck drivers - living in Garissa, and also in the Nairobi neighbourhood of Eastleigh, which is largely populated by people from the northeast.
They found that 22 percent of male respondents and 35 percent of female respondents in Garissa had engaged in transactional sex, while nine percent of men surveyed and 14 percent of women surveyed had been forced to have sex.
More than half the young people surveyed reported having multiple sexual partners and engaging in sex to acquire cell phones, clothing and jewellery; 41 percent of those with a regular sexual partner never used a condom.
"A friend can ask you to have a 'puff' [a brief sex session] with the lady he is pushing with," one Garissa student told researchers. "Such puffs become frequent and the lady ends up having many sexual partners at the same time."
The study also showed that many people from North-Eastern Province had low levels of knowledge about HIV, heightening their risk. Only one-third of the men and a quarter of the women named consistent condom use as a way to prevent HIV transmission, while just over half the women and 39 percent of the men identified faithfulness to one partner as a prevention strategy.
In Nairobi the main sources of information about HIV were television and other media, while in Garissa most people learned about it from religious leaders, parents and other family members.
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"The government always quarantines sick animals to protect those that are healthy; it should do the same to people with HIV/AIDS - we must be protected," Ibrahim Dekow, a miraa (local herbal stimulant) trader in Garissa, told IRIN/PlusNews.
The authors recommended intensifying HIV education programmes at schools, and targeting high-risk groups like miraa and milk vendors, sex workers and out-of-school youth with prevention programmes.
They also suggested working with religious leaders and using familiar faces - such as local women wearing the customary Islamic headscarf, or hijab - to deliver HIV prevention messages.
"We need a special approach to the HIV/AIDS programme in this province," said Anab Haji, of Garissa Simaho, a local community health organisation. "We are very different to other parts of Kenya, and our problems require different solutions."
na/kr/ks/he
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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